Interrogating assumptions about the relationship between service providers and recipients: Learning from a new service for survivors of In Care Abuse.

Understanding the dynamic relationship between service providers and the people who use their services is key to effective evaluation. This paper presents a practical approach to embedded evaluation that can be used by services to interrogate assumptions about relationships. The approach includes a simple framework for developing theories of change that centres relational aspects of the change process. This framework is complemented by a structured approach to surfacing risks and assumptions. Using the example of the evaluation of Future Pathways, a new and ground breaking service provided to people who experienced abuse or neglect as children In Care in Scotland, the paper describes how this approach was used in practice. Focusing in on assumptions identified by the service around trust, the paper describes the process undertaken to interrogate these assumptions through data collection with people using the service and staff. This process led to rich learning to support the development of the service as well as the identification of new elliptical assumptions. The paper concludes by sharing reflections on the learning from this work for the wider evaluation community highlighting the need for evaluators to take a relational approach to interrogating assumptions about relationships.

Partnership working and outcomes: do health and social care partnerships deliver for users and carers?

Working in partnership, both across social care and health and with service users, has been a persistent theme of the health and social care modernisation agenda in the United Kingdom. Despite a relatively underdeveloped evidence base, the development of health and social care partnerships has continued to feature in recent policy and legislative initiatives in the United Kingdom. At the same time there has been a major shift in focus towards the outcomes that support services deliver. A central question remaining is whether the policy initiatives driving the development of health and social care partnerships are delivering improved outcomes, particularly the outcomes valued by people who use services. This article outlines research designed to explore this issue across 15 health and social care partnerships in England and Scotland, building from previous research by the Social Policy Research Unit based at the University of York. It sought to assess the extent to which health and social care partnerships deliver the outcomes that people who use services value, and to determine the features of partnership working associated with the delivery of these outcomes. A robust outcomes framework was defined, which provided the basis for interviews with those receiving support from partnerships. Working with three user-researcher organisations, interviews were completed with 230 individuals in 2006. On the basis of this, some service users were able to identify features of partnership that particularly contributed to improved outcomes. These included continuity of staff and sufficient staff and a range of resources, including the availability of long-term and preventative services. Given the definitional and methodological complexity surrounding partnership working, and the challenges of attribution, the study faced some limitations in its ability to make wider inferences about partnership and outcomes. A theory of change should be employed in future studies of this type.

Risk management dilemmas in dementia care: an organizational survey in three UK countries.

Aims and objectives. The overall project aimed to understand the variability of the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. This paper focuses on the objective of identifying the understandings of risk by practitioners. Background. Risk management can result in a 'safety first' approach to care practices, but this may be disempowering for people with dementia. Design. This paper describes the results of the first stage of the study: a survey to service managers or equivalent in health, social and voluntary sector care organizations in three countries of the UK. Methods. Data from this stage was collection by postal questionnaire (n = 46). Results. Risk was portrayed as a multidimensional concept and clustered around three themes: (1) Risk and Independence, (2) Risk and Resource, and (3) Organizational Risk Management. Conclusions. Very wide understandings of risk are identifiable, ranging from avoidance of physical harm through to managed risk taking to improve quality of life, and to an appreciation of the impact of organizational and professional patterns of behaviour resulting in harm to the person with dementia. Relevance to clinical practice. Obtaining information about the perspectives of others may help to illuminate some of the dilemmas experienced by staff in this study, and the development of risk assessment frameworks may assist staff to resolve some of these.